Background Information:

What are the other Names for the Procedure?

• Nerve-Sparing Prostatectomy
• Simple Prostatectomy
• Surgery for Prostate Cancer

What is the Prostate Gland Removal surgical procedure?

• A Prostate Gland Removal or Prostatectomy is a surgical procedure that involves a partial or complete removal of the prostate gland
• This procedure is predominantly performed to treat prostate cancer or benign prostatic hyperplasia (a non-cancerous enlargement of the prostate)

What part of the Body does the Procedure involve?

The Prostatectomy procedure involves the prostate gland, urethra, urinary bladder, and rectum.

Why is the Prostate Gland Removal surgical procedure Performed?

The Prostatectomy procedure is performed for the following reasons:

• To restoring proper urine flow from within the ureter (urinary retention)
• To treat cancer of the prostate gland

What are some Alternative Choices for the Procedure?

In case of urinary retention, the transurethral resection of the prostate (TURP) procedure may be employed.

What are the Recent Advances in the Procedure?

The Prostate Gland Removal surgery may be performed with the help of a robotic system.

What is the Cost of performing the Prostate Gland Removal surgical procedure?

The cost of Prostate Gland Removal surgical procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding a Prostate Gland Removal procedure and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

http://www.nlm.nih.gov/medlineplus/ency/article/007416.htm (accessed on 06/11/2015)

Prior to Prostate Gland Removal surgical procedure:

How is the Prostate Gland Removal surgical procedure Performed?

The Prostate Gland Removal procedure may be performed under a general or spinal anesthesia.

• The surgeon makes an incision on the skin of the abdomen extending from below the belly button, up till the pubic bone
• After dissecting through the layers of the abdomen, the surgeon may perform either a Simple or Radical Prostatectomy depending on the indication for surgery
• A Simple Prostatectomy is done to treat a benign enlargement of the prostate and only the inner part of the gland is removed. The outer remaining portion of the prostate gland is sutured together
• In a Radical Prostatectomy, the entire prostate gland along with the sac-like organs called the seminal vesicles, are also removed. The surgeon may also remove the lymph nodes (collection of immune cells) to look for cancer spread
• A drain is left in place to drain any fluid collection after the surgery
• The procedure may also be done laparoscopically. The surgeon makes multiple small incisions on the abdomen to pass a tube fitted with a camera and surgical instruments to perform the procedure

Where is the Procedure Performed?

A Prostatectomy surgical procedure is performed in a hospital.

Who Performs the Procedure?

An urologist performs the Prostatectomy surgical procedure.

How long will the Procedure take?

A Simple Prostatectomy may take anywhere between 2-4 hours, while a radical procedure may take about 3-4 hours to perform.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Prostate Gland Removal procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for the Prostate Gland Removal (or Prostatectomy) procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Prostate Gland Removal surgical procedure?

Before a Prostatectomy, the patient has to undergo certain tests such as:

• Routine blood and urine analysis
• Chest X-ray
• Kidney function study
• Electrocardiography (ECG)
• Ultrasound imaging
• Cystoscopy
• Intravenous pyelogram (IVP)
• Biopsy of the prostate

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Prostatectomy procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
• What are the costs involved?

During the Prostate Gland Removal surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Spinal anesthesia by injection or general anesthesia by injection and inhalation is administered prior to the procedure.

How much Blood will you lose, during the Procedure?

The blood loss during the procedure depends on the type of surgical procedure adopted. However, an uncomplicated procedure does not lead to too much blood loss.

What are the possible Risks and Complications during Prostate Gland Removal surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
• Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders and chronic infections
• Poor immune system due to a variety of causes
• The possible risks or complications that may arise during the Prostate Gland Removal surgery are:
• Excessive bleeding
• Infection surrounding the surgical wound
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after Prostate Gland Removal surgical procedure?

• After the Prostate Gland Removal procedure, the patients are sent to an area of the hospital called the postoperative recovery area (or PACU)
• The patient’s blood pressure, heart rate, and respiration cycle shall be closely monitored. Any additional pain associated with the procedure will be treated
• Individuals are usually discharged from the hospital within 3-5 days of the procedure, if there are no complications

After the Prostate Gland Removal surgical procedure:

What are the possible Risks and Complications after Prostate Gland Removal surgical procedure?

The possible risks and complications that may arise after the Prostatectomy procedure are:

• Excessive bleeding from the surgical wound
• Signs of an infection around the surgical wound
• Loss of bowel or bladder function (incontinence)
• Erectile dysfunction (ED)
• Sterility
• Blood in the urine, frequent urge to urinate

What is the Prognosis after the Surgery?

A complete recovery from a Prostatectomy procedure is usually achieved. The prognosis is excellent without any serious complications being noticed.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Worsening pain and swelling of the surgical wound
• Excessive bleeding from the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness such as nausea, vomiting, constipation, or abdominal swelling
• Experiencing difficultly or pain while trying to urinate
• Prolonged erectile dysfunction (ED)
• Signs of an infection
• Headache, muscle aches
• Fever, feeling sick
• Dizziness
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after Prostate Gland Removal surgical procedure?

At home, the following post-operative care is recommended, after a Prostatectomy procedure:

• Slowly resume regular/daily activities as early as possible, which aids in faster recovery
• Use a heat pad or warm compress to relieve pain due to the incision
• Avoid all activities that are physically strenuous for about 6 weeks after the surgery (per physician’s advice)
• Resume showering and keep the wound clean and dry. Avoid taking baths until the surgical wound is completely healed. Gently wash the surgical wound with mild unscented soap
• Elevate legs while resting to prevent the formation of blood clots and reduce the possibility of swelling
• Complete the course of prescribed medication, as advised by your physician
• Take stool softeners to prevent constipation, under advice of the physician
• Take antibiotic medication to help combat or prevent infection, per your physician’s advice
• Avoid taking nonprescription medications such as aspirin. However, individuals may take acetaminophen to relieve pain (per the physician’s advice)
• Resume driving 1 week after being discharged from the hospital or when follow your physician’s instruction
• Avoid sex till a complete healing has taken place (as advised by your physician)
• Individuals are advised to have to clear liquids immediately after the surgery, until the gastrointestinal tract begins properly functioning. The individuals may then proceed to eat a well-balanced diet, which can aid in a faster recovery. It is better to avoid fluids or spicy foods that may worsen symptoms
• Also increasing one’s fluid intake can help prevent constipation and stress during bowel movements and urination

How long does it normally take to fully recover, from the Procedure?

It usually takes approximately 6 weeks to fully recover from this procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Prostate Gland Removal surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• A hospital
• An anesthesiologist (if anesthesia was administered)
• An urologist
• A pathologist

The patient is advised to inquire and confirm the type of billing, before the Prostate Gland Removal or Prostatectomy surgical procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA